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The Nasal Pillow
Regardless if you are seeking a new mask, or looking to start positive pressure therapy, one of the interests fixed within most new CPAP users minds is finding an interface that is easy to utilize and the least cumbersome. If you are doing your research and asking others what mask they prefer a very popular style is the nasal pillow. Some new users only associate CPAP therapy with a full face or nasal cushion style of mask, but the nasal pillow mask is becoming very prominent with the recent enhancements to mask technology! That is not to say that the older forms of the nasal pillow were not great options as for some, they certainly are and still are today! However, the newer style of nasal pillows have become less obtrusive and cumbersome offering a greater options for new patients as well. So do some research and look into the nasal pillow category, you may find a mask that offers everything you are hoping to find!

Which Mask to Choose?
Deciding which mask to use can be tough. There is such a great number of tools and information available to you; you can also ask your health care professional for help. Before being influenced by a medical professional, however, do some research! Look into reviews of different mask and the advice offered. It may mean the difference between an incredible night of sleep forever improving your health in comparison to not tolerating and struggling mightily. Remember that nearly every manufacturer allows for a mask exchange policy that your DME provider can utilized; meaning that if you use a new mask, but do not tolerate well and need to switch - it can be done at no charge to you through your DME provider. You have a safety! So review, research, question and decide! The nasal pillow mask is a viable option for any patient hoping initiate or maintain CPAP therapy providing some of the least cumbersome masks available on the market within the category.
Why choose a nasal pillow mask? The real question here is, why not?! If you believe you are a patient that has to use a full face mask, you may come to find that the nasal pillow, for you, is perfectly tolerable! With that, there is absolutely nothing wrong with hoping to wear the nasal pillow style despite what others may urge you to try for any reason. The nasal pillow is a very light form of mask offering the least amount of application area, which can minimize leaks. Most forms also have a minimal quantity of headgear thus creating a mask that is typically the least obtrusive of any style on the market. That alone is the largest drive for the nasal pillow. If that is enough information for you - then try it! If it doesn't work, once again remember that you have the thirty-day mask exchange option to try another style of mask to assure comfort. If that is your scenario then, at least, you have attempted this style and deciphered why or why not it works for you! Move on to a different style having learned.

Choosing the right nasal pillow.
To assure clear communication. I am only referencing the traditional nasal pillow style of CPAP mask, not any hybrid form.

After you have made the decision to be fit with a nasal pillow mask, the next step is to decide which in the category to use. As in every other category, there is a wide selection of different types to use that consist of slightly different shapes of the nasal pillow, frame, and headgear providing a slightly altered fit to a considerably different fit to match your preferences. When deciding on which of these masks to use, it is time to look into the mirror and study your face shape. These factors could influence your decision! As with the nasal cushion and full face styles the nasal pillow mask does have different sizes available, but there is one distinct difference in that the nasal pillow style. Most do not come with a fitting template. Without the suitable template it is entirely up to you, a technician, a therapist or provider to assure the right sized is used and adjusted. So to get the correct and most comfortable fit the nasal pillow style typically requires a small period of trial and error to try on the different masks within the category.
Understanding the areas where the nasal pillow cushions are going to be applied and rest on your face throughout the night will help you gauge which type of nasal pillows you hope to use. The pillows themselves are going to apply into the nostril reaching from the inner edge (columella) to the outer (alae). The pillow cushion will slightly press internally and externally to provide an adequate seal assuring that no pressure is too high in any one position. Depending on which mask it will also press against the upper portion of the lip to the tip of the nose (supra-tip). So depending on the size of your nostrils, upper lip and tip of your nose will impact what particular style may be best use for you!

The real question here is why does the nasal pillow dimensions become such a factor? Though small and light, it does need to fit properly to avoid irritations. When trying, these masks remember the areas the pillows press and attempt to prevent a nasal pillow that presses to greatly within your nostrils or primarily externally as well. You usually want a slight seal on both points of skin. You also don't want the mask to fit tightly causing the tip of your nose to have discomfort, although this will create an adequate seal! Always remember that depending on the model that the frame could rest against the upper lip and ultimately become very agitating. Take these points into account strictly when you are fitted.

The last portion to take note of is the headgear. Since this particular category has very minimal, that means it also has little support. Depending on the overall shape of your head to the texture of your hair the lack of support can become a factor. Be sure to maneuver your neck, roll on your side (if you can lay down) and try to assure that the mask will provide an adequate seal with little adjustment due to the lack of headgear support.

A Word of Caution!
Here is where I must interject and state something that I am not proud of having to admit. Sometimes when you are being fit with this style the cautions and pressure points I listed above are not taken seriously by your provider, respiratory therapist or technician. It is quite easy to get an adequate seal with this mask so that a fit test can go at an accelerated rate. Be careful and if you feel rushed slow your mask fit specialist down or request another. Remember that a great portion of being successful with your CPAP unit is your comfort with the mask you have chosen as this is not something to time press or take lightly. Take your time, evaluate and assure that you are comfortable with the fit.

If Problems Arise!
Just as with the traditional nasal and full face style, the nasal pillow category can come with several different issues. Sometimes these problems can have minor adjustments to the mask or other applications. So just as any other style of mask, if you are experiencing a problem or problems, do not give up on this style if you enjoy it! Attempt to fix the problem before opting a different mask hastily.

The first issue that can cause a problem is pressure. Not the pressure of the mask on the face or the headgear, but the actual air pressure from the CPAP machine. There are a great many of healthcare professionals that state a pillow style of mask should not be used for patients that are typically higher than a pressure setting of 10 or 12 cm of water pressure (usually 12). Due to the mask style being intolerable, uncomfortable and ineffective. I'd like to make my stance on this subject clear. It has been proven that nasal pillow is just as effective as a nasal cushion style of mask. Therefore, it is entirely untrue for anyone to suggest that a nasal pillow style is not effective. It is also untrue to state that this style of mask is not tolerable at a pressure setting greater than 10 cm of water pressure. It has also been proven that these masks are tolerable at high-pressure settings. So, the point is simple. The nasal pillow mask is equally as valid as any other mask and can be just as comfortable depending on who you are. Some may disagree with this, but this is my opinion. .
One of the main problems with this style of mask is caused by the jet stream of air that it creates leading to a domino effect for patients that can branch out into different concerns. In this instance, healthcare professionals get somewhat nervous about the pillow style as the pressure can be agitate. I have my philosophy, and it is simple. You do not know if this interface will work for you unless you try it. If you feel you want to try it then the pressure setting should be accounted for as if you are on a higher pressure then different problems could arise (just as any other mask category). Take note if the air exiting the pillow cushions is overwhelming or painful as this could lead to a considerable amount of discomfort and failing with this particular style.

Skin irritation, as with any mask, is the next focal point that can cause a problem. The pillows will be placed on the inner and outer portion of the nostril resulting in different forms of skin irritation. Some patients encounter this so severely they alternate between a nasal pillow and nasal cushion style of mask. And that is perfectly acceptable! The other alternative is using a water-based lubricant (do not use anything petroleum based) and apply a slight portion to the irritated part of the skin before applying the mask at night. The key is to not over apply as a high amount of lubricant can cause leaking. By creating a barrier between your skin and the pillows, it will moisturize and help with tenderness hopefully allowing for alleviation of the skin breakdown and discomfort.
They also make a product that is available for the traditional full face and nasal CPAP mask. The REMZZZ product line also makes a small cloth liner that can be placed between the nasal pillow and the nostril to help with relief as well. Remember insurance will not cover these accessories, they will be have to purchased entirely out of pocket in most cases.

Another common issue with the nasal pillow style is the lack of headgear support. Some masks within this style offer greater headgear support, but a great many do not. I would like to be clear that this is focusing on the newer forms of nasal pillow masks the majority are lacking in headgear support resulting in masks that could move throughout the night resulting in discomfort due to leaking. Some masks offer different approaches with straps that can be tightened - but that is sometimes not always the best option. So, when fitting the mask or on early nights of use take into account your movement as you sleep, what positional sleeping you typically use (side sleeping, sleeping on your back) and if the headgear holds to your head interacting between your head shape and hair texture.

A few mask suggestions!
Below is a list of masks that I typically have used and prefer to fit with from manufacturers Resmed, Respironics and Fisher and Paykel. These are by no means the only masks on the market, but the ones that most typical United States DME companies provide (some DME have wider options)! I hope you found this information helpful and have a great nights sleep! God bless!

Resmed:
Airfit P10/Airfit P10 For Her - Available in sizes extra small, small, medium and large.
Swift FX/Swift FX For Her - Available in sizes extra small, small, medium and large.
Swift LT/Swift LT For Her - Available in sizes extra small, small, medium and large.
Swift II - Available in sizes small, medium and large.

Respironics:
Nuance/Nuance Pro Gel - Available in sizes small, medium and large. Also, the Nuance comes with a fabric frame where the Nuance Pro Gel comes with a fabric/gel frame.
Respironics GoLife - Available in sizes s
mall, medium and large.

Fisher and Paykel:
Pillairo Q: Available in one size fits most.
Opus: Available in small, medium and large.

Useful Links

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.